Lying & Standing Blood Pressure 🩺
RCP lying and standing blood pressure procedure for falls risk assessment — record lying, 1-minute and 3-minute standing BP with symptom documentation and positive-result interpretation.
Overview
- Measurement of lying and standing blood pressure is part of a multi-factorial falls risk assessment. NICE NG249 recommends falls risk assessment for people aged ≥65, and those aged 50–64 at higher risk of falls.
- A manual sphygmomanometer is preferred if available — use it if an automatic machine fails to record.
- Document symptoms of dizziness, light-headedness, vagueness, pallor, visual disturbance, weakness, and palpitations.
Positive result (RCP)
- Drop in systolic BP of ≥20 mmHg on standing (with or without symptoms).
- Standing systolic BP below 90 mmHg, even if the drop is less than 20 mmHg (with or without symptoms).
- Drop in diastolic BP of ≥10 mmHg with symptoms (clinically less significant than systolic drop).
If positive
- Advise the patient of results.
- Inform the medical and nursing team.
- Take immediate actions to prevent falls and/or unsteadiness.
- Repeat regularly until resolved.
- Repeat the test if symptoms change.
Reference
Lying & Standing BP
RCP falls-risk orthostatic BP procedure with interpretation
Procedure
- Explain the procedure to the patient. Identify if assistance is needed to stand the patient and measure BP simultaneously.
- Use a manual sphygmomanometer if possible — especially if the automatic machine fails to record.
- First BP: after lying for at least 5 minutes.
- Second BP: after standing in the first minute.
- Third BP: after standing for 3 minutes.
- Repeat recordings if BP is still falling.
Lying BP
After lying for at least 5 minutes
Standing BP — 1 minute
Taken within the first minute of standing
Standing BP — 3 minutes
Taken after 3 minutes standing; repeat if BP still falling
Symptoms on standing
Related NICE guidance
NICENICE NG249 — Falls: assessment and prevention in older people and people 50 and over
Full guidance on nice.org.uk. BetterCall is not endorsed by NICE.
Educational reference only. Medical disclaimer